Provider First Line Business Practice Location Address:
310 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-882-3423
Provider Business Practice Location Address Fax Number:
509-882-3883
Provider Enumeration Date:
08/21/2006